Impact of coronary lumen reconstruction on the estimation of endothelial shear stress: in vivo comparison of three-dimensional quantitative coronary angiography and three-dimensional fusion combining optical coherent tomography
Impact of coronary lumen reconstruction on the estimation of endothelial shear stress: in vivo comparison of three-dimensional quantitative coronary angiography and three-dimensional fusion combining optical coherent tomography
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DOI：
10.1093/ehjci/jex222
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发表时间：
2018-10-01
影响因子：
6.2
通讯作者：
Park, Seung-Jung
中科院分区：
文献类型：
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作者：
Kweon, Jihoon;Kang, Soo-Jin;Park, Seung-Jung
目的 与单独的三维 (3D) 定量冠状动脉造影 (QCA) 相比，尚不清楚融合技术如何提高内皮剪切应力 (ESS) 预测的准确性。我们的目的是评估 3D QCA 与结合 3D QCA 和光学相干断层扫描 (OCT) 的 3D 融合模型之间在几何测量和血液动力学估计方面的差异。 方法和结果 在 20 名患者的冠状动脉模型中评估了计算流体动力学。在逐平面比较中，分别使用广义线性混合模型和一致性相关系数（CCC）评估差异和一致性。使用针对 1 毫米段计算的 CCC 值来表征最小管腔直径 (MLD) 周围的血液动力学特征。与3D融合模型相比，3D QCA显示出更短的最大管腔直径（2.54 +/- 0.67mm vs. 2.78 +/- 0.73 mm，P < 0.001）和更小的管腔面积（4.81 +/- 2.56mm(2) vs. 5.66 +/- 2.97mm(2)，P < 0.001），导致ESS（4.64 Pa 与 3.78 Pa，p = 0.029）。 3D 融合模型的更不对称的管腔形状更有可能分别与 3D QCA 模型中最大和最小管腔直径的低估和高估相关。周向 ESS 变化被 3D QCA 削弱，在基于分段的比较中，MLD 部位附近 (CCC = 0.370) 显示出最差的一致性。结论 3D 融合技术通过提供比 3D QCA 更准确的管腔特征，可能成为冠状动脉血流动力学模拟更相关的工具。
Aims It is not clearly elucidated how the fusion technique improves the accuracy of endothelial shear stress (ESS) prediction, in comparison with that of three-dimensional (3D) quantitative coronary angiography (QCA) alone. We aimed to evaluate the difference in geometric measurements and haemodynamic estimation between 3D QCA and a 3D fusion model combining 3D QCA and optical coherence tomography (OCT).Methods and results Computational fluid dynamics was assessed in the coronary models of 20 patients. In the plane-per-plane comparison, the difference and agreement were assessed using a generalized linear mixed model and concordance correlation coefficient (CCC), respectively. The haemodynamic feature around minimum-lumen-diameter (MLD) was characterized using CCC values calculated for 1-mm segments. In comparison with the 3D fusion model, 3D QCA showed a shorter maximum lumen diameter (2.54 +/- 0.67mm vs. 2.78 +/- 0.73 mm, P < 0.001) and smaller lumen area (4.81 +/- 2.56mm(2) vs. 5.66 +/- 2.97mm(2), P < 0.001), resulting in a significantly higher ESS (4.64 Pa vs. 3.78 Pa, p = 0.029). A more asymmetric lumen shape of the 3D fusion model was more likely associated with under-and overestimation of the maximum and minimum lumen diameters in the 3D QCA model, respectively. The circumferential ESS variations, which were blunted by 3D QCA, showed the worst concordance near the MLD site (CCC = 0.370) on segment-based comparison.Conclusion The 3D fusion technique may be a more relevant tool for the haemodynamic simulation of coronary arteries through providing more accurate lumen characterization than 3D QCA.